Telemedicine in the NHS: The benefits and costs of implementing telecare services

Health professionals agree patients will have to do more home monitoring in the future if the NHS is to cope with an expanding population. But how advanced is the telemedicine market in the UK, and how well is the NHS positioned to implement telecare services?

The NHS is continuing to feel the strain of demand across its services, with the UK population increasing by half a million in just one year from 2010. Health professionals and medical experts agree patients will have to do more home monitoring in the future if the NHS is to cope. But how advanced is the telemedicine market...

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in the UK, and how well is the NHS positioned to implement the necessary changes to provide telecare services?

Saving NHS costs with an aging population

Research from Ovum found 70% of NHS money goes into caring for people over the age of 65 and 60% of those suffer from chronic illness. With 10 million people 65 and over, a figure rapidly increasing, there is the potential to save a lot of money in this particular area.

Drew Provan, senior lecturer in haematology at The Royal London Hospital, Queen Mary's School of Medicine, believes it is imperative for the NHS to get as many patients out of hospital as possible. He says this can be done by enabling them to keep track of their blood pressure, temperature and other vital signs and then transmit that information back to a monitoring centre. A nurse should then be able to predict when they will become ill and intervene with a treatment, preventing that patient from having to be admitted to A&E, he says.

"In particular this could be used for patients with chronic disorders, such as diabetes and heart conditions, where all that needs checking is heart rate, blood pressure, weight and oxygen saturation. This could be used on apps on Androids and iPads, so the patient can keep a daily log which goes off to the centre looking after them," says Provan.

Data security and investment obstacles to telemedicine

But the biggest difficulty at the moment is letting outside data into hospitals, he says. "Secondary care is much slower in adopting these systems because of data security. But that's a hurdle we will just have to work through as this kind of technology is already available in other countries."

It will also take investment from the healthcare budget which the Department of Health (DoH) will have to agree to. "I know DoH is keen to use mobile tech, and Andrew Lansley is very pro iPad and apps, but they haven't identified the areas where they want to use it with yet. There needs to be more discussion about which diseases are best to monitor and how to deploy devices in the community.

"There have been lots of pilots in the UK, but no-one has yet decided which format to use, which disease to treat and which devices to deploy. All the bits of that have to be joined up by someone and we appear to be nowhere near that strategy yet."

But Provan believes deployment doesn't need to be hugely expensive, as people could use relatively inexpensive devices such as an iPod touch, and then download an app which is usually free. All they would need to do is stand on scales, for example, and tap in the information to their iPod touch. Or use a digital thermometer to put under their tongue to transmit a message via Bluetooth to the device, he says.

"We need investment, there's been pilot after pilot but someone actually needs to bite the bullet. At the moment people have to take the whole day off work sometimes just to take a test, which is ridiculous in some cases," Provan said.

Alison Mlot, member of the Healthcare Technologies and Medicine Knowledge Transfer Network, a government-funded organisation dedicated to exploiting technology in the health industries sector, agrees with Provan. She has been involved with hundreds of pilots testing telehealth. The next step is to focus on mainstreaming it, she says.

"The mobile technology industry is starting to understand there is no need for another black box which just sits in the house and that people want something like Apple technology, which they are used to," says Mlot.

Growing consumer demand for telecare

While telemedicine in the UK remains a nascent market, consumer demand for telehealth self-monitoring devices is growing. A number of telemedical devices are emerging such as for blood pressure monitoring, weight management and quitting smoking.

Most of the technologies for telemedicine are already established and the challenge lies in applying them to the health sector. There are many challenges when it comes to the practical application of these technologies such as interoperability, issues around sharing data, and standards - something which the Technology Strategy Board is currently working on, she says.

"There's lots of guidance around, but until it starts to be driven by government or the private market, it will remain slow. It's a no-brainer to say something has to change in the way we operate, and technology gives us the best option to do that. The industry is as frustrated as anyone at the moment because the routes to markets are blocked," she says.

But Cornelia Wels-Maug, Ovum analyst, believes more research is needed to win over the DoH. "The current sample sizes are not large enough to form a business case. We need some large-scale pilots that run longer than three days," she says.

The other issue is suitability, particular when discussing self-monitoring of the very elderly. "If you are vulnerable then the last thing you will want to do is learn self-treatment. But most of the time this is something patients learn fairly quickly. There have been studies in England where some sicknesses work better with telehealth than others, and again this is something we need more trials for," says Wels-Maug.

Why health and technology trails business in communications

Paul Flynn, doctor and deputy chairman of the British Medical Association's Consultants Committee, says technology in the health services doesn't have the same uptake as the business sector for two main reasons.

"Firstly there's the issue of confidentiality and worries that information on patients could be accidentally or deliberately accessed. So hospitals tend to use closed networks, the second issue is the cost. In the long-term this technology might save money in various ways, but the problem is these savings won't be realised for some time. And there has to be an initial expenditure in order to save. The NHS is often looking at very demanding targets, without the capacity to take a loss this year because of the future savings in a year to come," he said.

But Flynn also believes telehealth isn't a panacea for all patient conditions. "There are an awful lot of areas that are symptom-based and need more complex evaluations with the age-old instruments of eyes and ears."

Hospitals save costs with PCT telehealth care expenditure

The other big is issue is that primary and secondary care have traditionally operated in silos. "They are in different and competing parts of the NHS. So while self-monitoring may lead to cost savings in secondary care, the budget may have to come from primary care. The benefits that come about are a reduction in hospital admission, but primary care has to do the implementing."

Flynn says it is unlikely we will have the same amount of hospital units as we currently have. Rightly or wrongly, he says, technology can be used to justify such moves. "If you want to close down places, you are going to overstate benefits of potential for technology. And the potential is vast, but in terms of immediately realisable benefits, the case is sometimes overstated. There is an enormous potential there, but it shouldn't be used to replace doctors and nurses, although it can make their job easier and cut down on time wasting."

With major shake-ups in the NHS - particularly with changes in GP commissioning - it's difficult to say whether investment in telehealth will be accelerated or put on the backburner for the time being. But as we all experience the benefits of increased life expectancy, some of the onus of monitoring conditions will have to shift towards the patient, if the health service is to cope with an increased demand - and that is something the NHS has only limited time in delaying.

Case study: Kent NHS trials telecare services pilot study

Kent Telehealth Evaluative Development pilot

In 2005-2007 Kent NHS trialed a telehealth pilot with 250 patients suffering from chronic obstructive pulmonary disease (COPD), a lung disease. Each patient received a device to monitor vital signs.

Results were automatically uploaded to a central computer, where community matrons and practice nurses monitored them and were able to step in and advise or visit when necessary.

The results were COPD hospital admissions fell 50%, leading to savings for the primary care trust of between £30,000 to £40,000, allowing it to buy 15 more monitors.

Costs of hospital admissions were estimated at £2,000 each, so saving 50 admissions led to £1.2m savings per year for the PCT. Home visits were also cut by 80%, saving on travel costs, allowing healthcare providers to better prioritise their work.

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